Exam 3 Flashcards
1
Q
Beers Criteria
A
listing of drugs that carry high risks for older adults and criteria for potentially inappropriate medication use in older adults
2
Q
Biological Half life
A
the time necessary for half of a drug to be excreted from the body
3
Q
Pharmacokinetics
A
refers to the absorption, distribution, metabolism, and excretion of drugs
4
Q
Pharmacodynamics
A
refers to the biologic and therapeutic effects of drugs at the site of action or on the target organ
5
Q
Polypharmacy
A
use of multiple medications
6
Q
Age-related changes create
A
Pharmacokinetics
Pharmocodynamics
7
Q
Most common mediation?
A
Cardiovascular agents
8
Q
Decreased intracellular fluid, increased gastric pH, decreased gastric blood flow and motility, reduced cardiac output and circulation, and slower metabolism can slow drug absorption.
A
True
9
Q
Distribution changes in older adults
A
- changes in circulation
- changes in membrane permeability
- body temperature
- tissue structure
10
Q
If your liver is not functioning.. you will not
A
LIVE
11
Q
Liver influences what?
A
Drug detoxification and excretion
12
Q
As you get older what is the central nervous system increasingly sensitive to
A
- alcohol
- narcotics
- bromides
13
Q
What is an early identifier to adverse reactions to medications in older adults ?
A
Change in mental status
14
Q
Varying degrees of mental dysfunction are often the early signs of adverse reactions to commonly prescribed medications for older adults.
A
True
15
Q
Most common route to administering drugs ?
A
Oral
16
Q
Fastest route of drug administration?
A
IV
17
Q
Aspirin can cause?
A
Intestinal bleeding
18
Q
Acetaminophen
A
lacks anti inflammatory properties can cause liver failure ( hepatic necrosis)
19
Q
Short Acting Opioids are for ?
A
Mild/ Moderate pain can cause constipation
20
Q
Long acting opioids
A
Severe pain can cause constipation and gastric immobility
21
Q
What is acetaminophen commonly used to treat
A
osteoarthritis
22
Q
What is acetaminophen used for ?
A
Mild to Moderate Pain
23
Q
What should the daily does of acetaminophen not exceed ?
A
4,000 mg
24
Q
What should not be used for people who have liver disease ?
A
Acetaminophen
25
What is one thing you should avoid doing within two hours go giving an antacid?
Avoid administering any other medications within two hour to prevent the antacid from interfering with drug absorption
26
What can excessive antibiotic use lead to ?
antibiotic resistant bacteria
27
Which of the following classifications of antibiotics requires close monitoring for hearing loss and renal failure ?
Amino-glycosides
28
Why do ahminoglycosides require close monitoring
because they can increase the risk of hearing loss and renal failure
29
What are the two main Anticoagulants
Heparin and Coumarin
30
When must you administer anticoagulants?
You must administer anticoagulants at the same time to maintain a constant blood level
31
What do anticoagulants put you at a higher risk for
Bleeding
32
What foods can reduce the effectiveness of anticoagulants
those foods rich in vitamin K .
33
Mango and Papaya can increase what ?
INR
34
Why should patients avoid aspirin with anticoagulants
it can interfere with platelet aggregation and it can cause bleeding
35
What are some possible side effects of anticoagulants
```
bruising
pallor
weakness
jaundice
confusion
agitation
```
36
What can anticoagulants depress
psychomotor activity
37
Should anticonvulsants be stopped abruptly
NO
38
Can grapefruit juice be ingested while taking
No it increases the risk of toxicity
39
what patients should be monitored closely while taking anticonvulsants
those with glaucoma, CAD, prostate disease
40
What can anticonvulsants cause
photosensitivity
41
What is the most common antihypertensive drug
diuretics
beta- blockers
calcium channel blockers
42
What is important to monitor when taking antihypertensives drugs
monitoring potassium
43
What do NSAID's have ?
A narrow therapeutic window
44
NSAID's have to be taken with what
food or a glass of mild, to reduce GI irritation
45
What should be monitored when taking cholesterol lowering drugs
ensure that patients receive liver function tests
46
Cholinesterase Inhibitors
Aricept, Exelon, and Razadyne
47
What are some signs of digoxin toxicity
bradycardia, diarrhea, anorexia, nausea, and vommiting
48
Which patients are more susceptible to digoxin toxicity
Those with hypokalemia
49
Main diuretic types
Thizaides , loop diuretics, potassium sparing diuretics
50
What can diuretics worsen in patients ?
existing liver disease, renal disease, gout, and pancreatitis and raise blood glucose in diabetics
51
What should be routinely tested for those who are on diuretics
Serum electrolytes, glucose, and BUN
52
Types of Laxatives
Bulk formers, stol softeners, hyperosmolars, stimuleren, and lubricants
53
What is important to educated patients on when they are taking laxatives
to maintain a good fluid intake
54
What are some examples of psychoactive drugs
Anti-anxiety drugs ( anxiolytics)
Antidepressants
Antipsycholtics
Sedatives/ hypnotic
55
What is an uncomfortable side effect of antidepressants
Mouth dryness
56
What classification of antidepressants have the most issues in older adults
Trycyclic antidepressants
57
Older adults are more sensitive to anticholinergic effects of medications, what do the side effects include
dry mouth, constipation, urinary retention, blurred vision, and insomnia
58
What are the two things that patients are at risk for the most when taking antipsychotics
falls due to hypotensive effects, and constipation
59
What is important to evaluate when sedatives are used
Insomnia
60
Neuropathic Pain
Occurs from abnormal processing of sensory stimuli by the central or peripheral nervous system
61
Nociceptive Pain
Arises from mechanical, thermal, or chemical noxious stimuli, can be somatic or visceral (by central or nervous system)
62
Somatic Pain
bone of soft tissue masses; localized, throbbing and aching
63
Visceral Pain
disorders that cause generalized or referred pain, deep, and aching
64
Neuropathic pain description
Sharp, stabbing, tingling, burning, onset of high intensity
65
Somatic Pain description
well ,localized, throbbing, pr aching
66
Complications of Unrelieved Pain
a. Limited mobility
b. Develop pressure ulcers
c. Pneumonia
d. Constipation
e. Poor appetite
f. Depression, hopelessness
g. Spiritual distress
67
Mr. D suffers from late stage dementia. Which behavior indicates that he is in pain?
a. Agitation and decreased socialization
68
What are some complementary therapies
Aromatherapy, herbal, and supplements
69
Which mediation, commonly used for pain, is contraindicated in the older adult related to potential side effects
Propoxyphene ( Darvocet)
70
Why is Darvocet contraindicated for older adults
because it has the potential for CNS and Cardiac toxicity
71
Macroenvironment:
elements in the larger world that affect groups of people or entire populations
72
Microenvironment:
the immediate surroundings with which a person closely interacts
73
Restraint
anything that restricts movement, can be physical or chemical
74
Microenvironment
immediate surroundings
75
Macroenviornment
elements in larger world
76
Recommended room temperature
75 degrees
77
Taking more than one drug can increase the risk of what
Drug/ food interactions
78
Ginkgo Biloba
anticoagulant effect, irritability, restlessness, insomnia, nausea, vommiting, diarrhea, and increase effects of anticoagulants
79
Ginseng
Can increase blood pressure and insomnia
80
St.Johns Worth
acts as monamine oxidase inhibitor , hypertension, photosensitivity, nausea and vommiting
81
What conditions can decrease the metabolism of drugs
dehydration, hyperthermia, immobility, and liver disease
82
How is creatinine clearance calculated
age, weight, and serum
83
Pharmacodynamics
the biologic therapeutic effect of drugs at the site of action or on the target organs
84
Signs and symptoms of adverse reactions...
Differ in older person
85
A prolonged time may be required for...
adverse reaction in older adults
86
Can a drugs adverse reaction be demonstrated even after the drug has been discontinued
Yes
87
can adverse reactions develop suddenly
yes the patient can be on the drug for a long period of time before reactions occur
88
What is an early symptom of adverse reactions
mental dysfunction
89
inappropriate drug to use in adults
Pentazocine
90
What is important to ensure that oral medications achieve full benefit
Encourage oral hygiene, ample fluids, and proper positioning for swallowing
91
What type of tablets should not be crushed
enteric coated and sustained release tablets
92
What is one of the risk factors or medication errors
Cognitive impairment
93
What is the mold widely used pain medication in older adults
Analgesics
94
What is the most common NSAID in older adults
Aspirin
95
What are some secondary infections from antibiotic therapy that can cause discomfort
oral thrush
colitis
vaginitis
96
What are some additional things that anticonvulsants can be used to treat
bipolar disorders, neuropathic pain, migraine prevention
97
What do beta blockers stop
the effects of sympathetic division
98
What do beta blockers side effects include
dizziness, fainting, Brady cardia and CHF
99
What is bulk formers intentions
to absorb fluid in the intestines
100
Why is poly pharmacy a concern in the elderly
metabolic changed, reduced drug clearance
101
What is the risk of polypharmacy
Increased healthcare costs
Drug interactions
medication non adherence
102
What are the causes of poly pharmacy
Demographic factors
health factors
access to healthcare
103
What is meant by the term poly pharmacy
multiple medications taken by patients
| two medications at a time to 18, or to more medications than clinically necessary
104
How is poly pharmacy treated
1. obtain accurate medication and medical history
2. link each prescribed medication a disease state
3. reconcile medications upon any discharge from hospital of SNF
105
The nurse provides instructions about the medication safety to the older adult. Which instruction is appropriate
C. Ask healthcare provider to describe the purpose of the medications
106
An older adult client who is cognitivley impaired is demonstrating signs of being in pain . How should the nurse evaluate the patients pain level
A. Ask the client to numerically rate the pain
B. Observe the client over the next several hours
c. provide the patient with a vigil analogue scale to gauge the pain
d. go through the questionnaire with the client
C. provide the patient with a vigil analogy scale to gauge the pain
107
An older client has difficulty swallowing oral medications and sometimes spits them out after the nurse leaves the patients room. which action should the nurse take to ensure the patient takes the medication ?
A. Crush any large or enteric coated tablets
B. prescribe liquid or suppository forms of the medications
C. give the client ample fluids to make swallowing easier
D. having the client hold the medicine in the mouth until being able to swallow
C. give the client ample fluids to make swallowing easier
108
The nurse is performing a home visit to an older client who has a history of obesity, and poor controlled hypertension. Which assessment finding would alert the nurse to possibility of a problem
A. the patient has started taking st. johns wort to increase stamina and concentration
B. the client has an increasing intake of green tea to obtain more antioxidants
c. the client has begun low does aspirin for the prevention of cardiac disease
D. the client takes insulin injections x3 for treatment of type 1 diabetes
A. the patient has started taking st. johns wort to increase stamina and concentration
109
an older female patient states she has been taking 1 mg of lorazepam at bedtime , when experiencing episodes of anxiety . Which response by the nurse would be most appropriate?
A. have you ever been diagnosed with a condition called generalized anxiety disorder
B. have you considered other methods beyond medication to help you sleep and to relieve anxiety
C. the drug can lead to problems with coordination that may lead to Parkinson's disease
D. drugs like this have been shown to be inappropriate and ineffective
B. have you considered other methods beyond medication to help you sleep and to relieve anxiety
110
A nurse understands that poly-pharmacy can lead to
a. adverse drug reactions
b. drug dependency
c. lack of effective on quality of life
d. herbal remedies
A. adverse drug reactions
111
```
The gerontological nurse knows that the most commonly used drugs in the elderly include which of the following. SATA
A. Anti-hypertensives
B. Analgesics
C. Antibiotics
D. Antacids
```
A,B,C
112
A medication is effected by taking with a full stomach of fatty foods, an antacid and bed rest . What base of pharmo-kinetics is be effected ?
Absorption
113
When the 70 year old women complains " I weigh the same as I did when I wore a size ten, and now I can barely squeeze into a size 16" the nurse explains which of the following
A. post menopausal women gain weight as it relates to calcium
B. metabolism in the older adult creates increased adipose tissue
c. kyphosis causes a re distribution of weight
d. denial can be very powerful in how a person perceives their weight
metabolism in the older adult creates increased adipose tissue
114
```
An elderly patient is prescribed digoxin six months later the patient comes in for a checkup with the provider . Her digoxin levels are normal. what would the longterm nurse expect the provider to do?
A. increase the dose
B. decrease patient monitoring
c. decrease the dose
D. discontinue the medication
```
Decrease monitoring of the patient
115
A patient has failed to lower their cholesterol level in spite of attempting to modify their lifestyle for the past six months . What agent does a nurse anticipate will be initiated this time ?
Statins
116
Which single drug class is known to be most effective I reducing the major types of hyper limpedemia
Statins
117
The nurse knows that what drug is recommended for Alzheimers treatment ?
Namenda
Aricept
Exelon
